Dear Lydia,
I wanted to connect with you one more time. I really did not have time to say goodbye. You left the world so suddenly. I am grieving for you; yes, patients may not know this, but we doctors grieve too. I’ve been carrying around the memorial card with your photo on it from your wake. I went to your wake but of course you know that, you were there too. Lying there, so calmly. It startled me as I only knew you as a very talkative person often in so much distress. Asking, pleading, begging at times for a higher dose of your pain medication.
I spoke with your family, and we cried together standing there in the greeting line. Your son-in-law almost couldn’t let go of my hand as I apologized for not being able to do more. Your oldest daughter thanked me and reminded me how complex and stubborn you were. We all tried so hard.
So, I have your laminated memorial card tacked up on the cork board that hangs over my desk at work. It reminds me that when the opioid crisis reached its peak I would not be one of “those” doctors. The ones who stop their patients’ opioid medications only to read about them in the obituaries. I created pain agreements, monthly visits, a pain group, urine tox screen protocols, etc. My plan was foolproof. I had rules.
But addiction does not follow rules, nor respect them. You broke them all, or at least your substance use disorder did. First chance. Second chance. Third chance. Fourth chance. Fifth chance. Excuse, reason, tears.
I offered vivitrol, suboxone, a methadone program. Did I know you would overdose? Did I worry?
I’m sorry you’re gone at age 57. And I am truly sorry that I did not know how vibrant your life was until I went to your wake. When I visited you at home or when you came to the office with your oxygen tank, we did not talk about friends, family, hobbies, past jobs; we talked about pain agreements and pain medications. Each visit was similar: How are you? Are you taking your medications properly? Your last urine tox screen shows you had something else in it. You can be honest with me; I really want to help. Please consider seeing our therapist. Please consider going inpatient for a while. I will see you in 4 weeks. Looking back, I am ashamed that was all I asked, all I offered. Maybe I had reached my limits; maybe I was tired; maybe I had given up. Whatever it was, it was not right.
You said you were sorry when I confronted you about using other substances. You said you were just trying to treat your pain. You said you knew I was trying to help. You thanked me for caring, for coming to your home. I am not sure I ever responded properly to your apology or gratitude.
But in the end, you held fast; you were not going to get more help. Lord, I wish I had convinced you otherwise, or learned more about you then so I could understand what was behind your thoughts and reasons. I wish I had been more innovative in my care. You taught me to be more curious, more creative, and to love each patient like a family member. I am trying with those who have followed. I am teaching this to my students too. You might even be proud since you were a nurse long ago.
You have taught me many, many lessons. They are grafted deep in my doctoring soul.
At your wake, the cars just kept coming and coming. The videos and photos of your youth moved me; you were so beautiful as a mother, a nurse, a neighbor. I only knew you with your oxygen tank, by yourself, with grey hair, and the smell of tobacco. I did not really know you at all. I lament.
You are welcome.
More importantly, thank you.
You are forgiven.
And most importantly, I am sorry.
And you were loved, really loved.
Sincerely,
Dr Silk
